Presented the case of an 11-year-old boy with vocal-cord dysfunction (VCD) as an example of a rare clinical phenomenon that may result in clinical and systemic challenges for the pediatric psychologist. VCD presents as highly similar to asthma, yet is best treated with speech therapy and psychosocial intervention. The physical symptomatology of VCD and its conceptualization as a psychosomatic disorder are described. Difficulties inherent in integrating psychological factors into medical case formulation are discussed, and possible pitfalls and strategies are delineated.